Patients with intractable pain from chronic pancreatitis or pancreatic cancer can benefit from a celiac plexus block or celiac plexus neurolysis. This procedure is performed endoscopically, with sedation similar to what is given during a routine colonoscopy. The procedure involves using Endoscopic Ultrasound to identify the celiac plexus, a block of nerves that are responsible for pain from the pancreas. This block of nerves is then injected with an anesthetic agent to deaden the nerves either temporarily (block) or permanently (lysis).

Patients with intractable pain from chronic pancreatitis or pancreatic cancer can benefit from a celiac plexus block or celiac plexus neurolysis. This procedure is performed endoscopically, with sedation similar to what is given during a routine colonoscopy. The procedure involves using Endoscopic Ultrasound to identify the celiac plexus, a block of nerves that are responsible for pain from the pancreas. This block of nerves is then injected with an anesthetic agent to deaden the nerves either temporarily (block) or permanently (lysis).

Many patients with cancer of the gastrointestinal tract will receive radiation therapy as part of their therapy. Fiducials are small cylinders of gold that are implanted inside a tumor and can be identified radiographically to allow precise application of radiation to the desired location. These gold cylinders are placed endoscopically. The procedure involves identifying the tumor on Endoscopic Ultrasound, and then placing the gold cylinders circumferentially around the borders of the tumor.

Approximately 5-15% of patients with pancreatitis, or inflammation of the pancreas, will develop a walled off collection of fluid called a pancreatic fluid collection. These collections can be painful and/or become infected, in which case drainage of the collection is required. Traditionally, these collections required drainage via surgery or via a tube inserted through the skin, but now we have the capability to drain them from the inside without the need for external tubes or incisions! This is done by seeing the collection using Endoscopic Ultrasound and placing a stent from the collection into the lumen of the gastrointestinal tract allowing for the drainage to occur into the gastrointestinal lumen directly.

Approximately 5-15% of patients with pancreatitis, or inflammation of the pancreas, will develop a walled off collection of fluid called a pancreatic fluid collection. These collections can be painful and/or become infected, in which case drainage of the collection is required. Traditionally, these collections required drainage via surgery or via a tube inserted through the skin, but now we have the capability to drain them from the inside without the need for external tubes or incisions! This is done by seeing the collection using Endoscopic Ultrasound and placing a stent from the collection into the lumen of the gastrointestinal tract allowing for the drainage to occur into the gastrointestinal lumen directly.

However, sometimes the material in the collection gels together to become solid, in which case drainage cannot occur through the stent. For these patients, we offer the ability to perform necrosectomy, which involves taking a standard endoscopy scope and advancing it through the stent into the collection, at which point solid debris can be grabbed and removed by hand. This is an arduous task, and in some cases takes many sessions to see improvement, but is worth it in the end because only after removal of the solid material will the collection heal.

When the gallbladder gets obstructed, the bile that is stored there is unable to drain. This leads to distension of the gallbladder, causing pain and acting as a nidus for infection. Whenever possible, the gold standard treatment is removal of the gallbladder via surgery. However, there are many patients who are not able to undergo surgery due to age, concurrent medical conditions, severity of illness, etc. Traditionally, the only alternative for those patients was a drain from the skin into the gallbladder, to be left in place indefinitely. However, now we have the option to drain the gallbladder from the inside! This is done by visualizing the gallbladder using endoscopic ultrasound and placing a stent from the gallbladder into the stomach or small intestine.

Patients with obstruction of the bile duct or pancreatic duct require a procedure called ERCP. This procedure involves accessing these ducts through their normal connection point to the intestine in order to remove the obstructing agent and sometimes place a stent to stretch open the area of obstruction. However, a small percentage of patients cannot have the blockage relieved with standard ERCP. The alternative for these patients used to be surgical intervention or placement of a drainage catheter from the skin into the ducts. However, now we have the technical skill and capability at RWJUH to drain these ducts from the inside! This involves making a new connection from the stomach or small intestine into the bile duct or pancreatic duct and placing a drainage stent across the new connection.

Gastric bypass is growing in popularity as an efficacious treatment for obesity. However, the procedure involves re-routing of the gastrointestinal lumen, resulting in the bile duct-intestinal anastomosis to be very far away from the gastrointestinal lumen. For patients who develop gallstones after gastric bypass, this is a problem as it is very difficult to access the bile duct in order to remove the stones. Consequently, Dr. Michel Kahaleh, the leader of the advanced endoscopy team here at RWJUH, invented a procedure called the “EDGE” procedure to overcome this difficulty. This procedure involves connecting two areas of the gastrointestinal lumen by placing a stent between the native and bypassed stomachs under endoscopic ultrasound, in other words creating a bridge to shorten the distance to the ampulla and allow for stone removal.

Sometimes, diseases of the gastrointestinal tract cause obstruction of the stomach preventing the passage of food from the stomach into the intestine. Surgery with re-routing of the intestines is an option for these patients. However, recently a minimally invasive endoscopic alternative was developed which allows for bypassing of the obstruction all from the inside! This procedure involves identifying the small intestine beyond the area of blockage, and placing a stent from there into the stomach. This allows patients to continue to eat and avoids the need for an invasive operation.